Subscribe to RSS
DOI: 10.1055/s-0032-1315039
Antiarrhythmische Therapie bei Vorhofflimmern
Antiarrhythmic Drug Therapy for Atrial FibrillationPublication History
Publication Date:
15 August 2012 (online)
Zusammenfassung
Vorhofflimmern tritt bei einer Vielzahl kardiologischer Grunderkrankungen auf und führt in vielen Fällen zu beträchtlicher Symptomatik. Die Rhythmusstörung sollte zunächst (nach Einleitung einer oralen Antikoagulation entsprechend Risikoscores) mit einer Medikation zur Kontrolle der Kammerfrequenz behandelt werden. Führt dies nicht zu der erwünschten Besserung der Beschwerden, ist eine Therapie zu Wiederherstellung und Erhalt des Sinusrhythmus indiziert. Kommt es hierunter zu symptomatischen Rezidiven sollte die Indikation zu einer Ablationstherapie geprüft werden.
Abstract
Atrial fibrillation occurs in the context of several cardiac disease entities and may lead to significant symptoms. In general, the arrhythmia should initially (after initiation of an oral anticoagulation according to risk stratification schemes) be treated in an attempt to control ventricular rate. If this does not lead to sufficient relief of symptoms, further medical therapy that aims at restoration and maintenance of sinus rhythm should be applied. If there are still symptomatic relapses with such medication an ablation therapy should be considered.
-
Literatur
- 1 Camm AJ, Kirchhof P, Lip GY et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010; 31: 2369-2429
- 2 Van Gelder IC, Groenveld HF, Crijns HJ et al. Lenient versus strict rate control in patients with atrial fibrillation. N Engl J Med 2010; 362: 1363-1373
- 3 Hohnloser SH, Kuck KH, Lilienthal J. Rhythm or rate control in atrial fibrillation – Pharmacological Intervention in Atrial Fibrillation (PIAF): a randomised trial. Lancet 2000; 356: 1789-1794
- 4 de Denus S, Sanoski CA, Carlsson J et al. Rate vs. rhythm control in patients with atrial fibrillation: a meta-analysis. Arch Intern Med 2005; 165: 258-262
- 5 Roy D, Talajic M, Nattel S et al. Rhythm control versus rate control for atrial fibrillation and heart failure. N Engl J Med 2008; 358: 2667-2677
- 6 Corley SD, Epstein AE, DiMarco JP et al. Relationships between sinus rhythm, treatment, and survival in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Study. Circulation 2004; 109: 1509-1513
- 7 Dagres N, Kottkamp H, Piorkowski C et al. Influence of the duration of Holter monitoring on the detection of arrhythmia recurrences after catheter ablation of atrial fibrillation: implications for patient follow-up. Int J Cardiol 2010; 139: 305-306
- 8 Hohnloser SH, Pajitnev D, Pogue J et al. Incidence of stroke in paroxysmal versus sustained atrial fibrillation in patients taking oral anticoagulation or combined antiplatelet therapy: an ACTIVE W Substudy. J Am Coll Cardiol 2007; 50: 2156-2161
- 9 Lafuente-Lafuente C, Mouly S, Longas-Tejero MA et al. Antiarrhythmic drugs for maintaining sinus rhythm after cardioversion of atrial fibrillation: a systematic review of randomized controlled trials. Arch Intern Med 2006; 166: 719-728
- 10 Freemantle N, Lafuente-Lafuente C, Mitchell S et al. Mixed treatment comparison of dronedarone, amiodarone, sotalol, flecainide, and propafenone, for the management of atrial fibrillation. Europace 2011; 13: 329-345
- 11 Ehrlich JR, Biliczki P, Hohnloser SH et al. Atrial-selective approaches for the treatment of atrial fibrillation. J Am Coll Cardiol 2008; 51: 787-792
- 12 Ehrlich JR, Gotte A. [Remodeling by atrial fibrillation and clinical implications for cardioversion]. Dtsch Med Wochenschr 2011; 136: 2212-2216
- 13 Ehrlich JR, Hohnloser SH. [Pharmacological cardioversion of atrial fibrillation]. Z Kardiol 2005; 94: 14-22
- 14 Klein AL, Grimm RA, Murray RD et al. Use of transesophageal echocardiography to guide cardioversion in patients with atrial fibrillation. N Engl J Med 2001; 344: 1411-1420
- 15 Chevalier P, Durand-Dubief A, Burri H et al. Amiodarone versus placebo and classic drugs for cardioversion of recent-onset atrial fibrillation: a meta-analysis. J Am Coll Cardiol 2003; 41: 255-262
- 16 Santangeli P, Di Biase L, Pelargonio G et al. The pharmaceutical pipeline for atrial fibrillation. Ann Med 2011; 43: 13-32
- 17 Alboni P, Botto GL, Baldi N et al. Outpatient treatment of recent-onset atrial fibrillation with the “pill-in-the-pocket” approach. N Engl J Med 2004; 351: 2384-2391
- 18 Buccelletti F, Iacomini P, Botta G et al. Efficacy and safety of vernakalant in recent-onset atrial fibrillation after the European Medicines Agency approval: systematic review and meta-analysis. J Clin Pharmacol 2011; Epub ahead of print
- 19 Roy D, Pratt CM, Torp-Pedersen C et al. Vernakalant hydrochloride for rapid conversion of atrial fibrillation: a phase 3, randomized, placebo-controlled trial. Circulation 2008; 117: 1518-1525
- 20 Santangeli P, Di Biase L, Burkhardt JD et al. Examining the safety of amiodarone. Expert Opin Drug Saf 2012; 11: 191-214
- 21 Hohnloser SH, Crijns HJ, van Eickels M et al. Effect of dronedarone on cardiovascular events in atrial fibrillation. N Engl J Med 2009; 360: 668-678
- 22 Singh BN, Connolly SJ, Crijns HJ et al. Dronedarone for maintenance of sinus rhythm in atrial fibrillation or flutter. N Engl J Med 2007; 357: 987-999
- 23 Connolly SJ, Camm AJ, Halperin JL et al. Dronedarone in high-risk permanent atrial fibrillation. N Engl J Med 2011; 365: 2268-2276
- 24 Singh BN, Connolly SJ, Crijns HJ et al. Dronedarone for maintenance of sinus rhythm in atrial fibrillation or flutter. N Engl J Med 2007; 357: 987-999
- 25 Kober L, Torp-Pedersen C, McMurray JJ et al. Increased mortality after dronedarone therapy for severe heart failure. N Engl J Med 2008; 358: 2678-2687
- 26 Morrow DA, Scirica BM, Karwatowska-Prokopczuk E et al. Effects of ranolazine on recurrent cardiovascular events in patients with non-ST-elevation acute coronary syndromes: the MERLIN-TIMI 36 randomized trial. JAMA 2007; 297: 1775-1783
- 27 Miles RH, Passman R, Murdock DK. Comparison of effectiveness and safety of ranolazine versus amiodarone for preventing atrial fibrillation after coronary artery baypass grafting. Am J Cardiol 2011; 108: 673-676
- 28 HARMONY:. http://www.clinicaltrials.gov/ct2/show/NCT01522651?term=HARMONY&rank=8
- 29 Burashnikov A, Sicouri S, Di Diego JM et al. Synergistic effect of the combination of ranolazine and dronedarone to suppress atrial fibrillation. J Am Coll Cardiol 2010; 56: 1216-1224
- 30 Scirica BM, Morrow DA, Hod H et al. Effect of ranolazine, an antianginal agent with novel electrophysiological properties, on the incidence of arrhythmias in patients with non-ST-segment-elevation acute coronary syndrome. Circulation 2007; 116: 1647-1652